2.2 Mmi Exam 1: Uti

Front 1

what are high risk groups of UTI

Back 1

general pop and sexually active women esp ones that use diaphragm with spermicide

(female urethra shorter, ascending route of infection)

Front 2

why are spermicides a RF for UTI

Back 2

they increase colonization of vagina with uropathogens and increase adherence of E. Coli to vaginal epithelial cells

Front 3

what sx accompany cystitis and what location does it occur in

Back 3

FUD
frequency, urgency, and dysuria
occurs in suprapubic area

Front 4

what will you find in the urine of pts with cystitis

Back 4

bacteria, WBC, sometimes hematuria

*may appear malodorous or bloody

Front 5

how does urine from acute pyelonephritis differ from cystitis

how do sx differ?

Back 5

WBC, CELLULAR CASTS*, bacteria, and *PROTEIN

fever, sepsis, dec kidney fxn (more severe)

--> can progress to nephron loss & renal failure (if untreated)

Front 6

if you have glomerulonephritis, what will you see in the urine

Back 6

plasma protein and blood cells

Front 7

what are the MCC of cystitis

Back 7

E. Coli*

Klebsiella, Proteus, staph saprophyticus, serratia marcescens, pseudomonas aeruginosa, enterococcus faecalis

Front 8

cystitis is more common in women why?

Back 8

short urethra and location is near anal opening allowing for fecal contamination

Front 9

what usu precipitates prostatitis

Back 9

bladder or urethral infection and often dt catheterization

Front 10

what are some virulence factors for UTIs

Back 10

adherence to vaginal and uroepithelial cells
cytotoxic, necrotizing factors
hemolysin

(fimbriae, pili, outermembrane proteins)

Front 11

the genes for the virulence factors are linked together as multigene segments and called what

Back 11

pathogenicity islands

Front 12

what determines the anatomical location of infections in UTIs

Back 12

adhesive properties

(E. coli pyelonephritis isolates adhere better than cystitis isolates, uroepithelial cells better than fecal)

Front 13

what are the main things to know about e. coli

Back 13

G neg bacillus

normal colon flora

dry pink colony on MacConkey (lactose +)

Nitrite +

cannot use citrate as sole carbon source
facultative anaerobes
virulence factors= pili and LPS endotoxin (inflammation)
MC cause of UTI

Front 14

what is the tx for e. coli

Back 14

Peniclillin, ciprofloxacin

Front 15

what are the main things to know about proteus vulgaris/mirabilis

Back 15

G neg bacilli

isolate from urine
facultative anaerobes
opportunistic, transmitted via catheters
enteric bacteria

nitrite positive
urease positive **- raises pH via urea --> ammonia (yellow--> pink)
HIGHLY MOTILE **peritrichous flagella, swarm on agar media

Front 16

Proteus mirabilis is the 2nd MC cause of UTI. however, unlike e. coli, it will infect _________ more commonly than e. coli

What individuals does it commonly occur in?

Back 16

kidneys

individuals w/ structural abnormalities or elderly catheterized pts

Front 17

what are some things proteus mirabilis produces to invade and attach to host?

What provides the main virulence ?

Back 17

pore forming hemolysins
endotoxin
urease
adhesins
pili, fimbriae, flagella, biofilm formation

virulence d/t swarming ability--> protease & hemolysin specific to swarmer bacteria

Front 18

because of its ability to hydrolyze urea --> ammonia, what are pts with proteus mirabilis at risk for

Back 18

with the pH rising dt increased ammonia, pts are at increased risk for struvite (magnesium ammonium phosphate) stones and calcium phosphate stones

Front 19

what is paranitrophenyl glycerol (PNPG)

Back 19

it is a tx for proteus mirabilis undergoing research right now.

it is an anti swarming agent which inhibits expression of hemolysins, proteases, flagella

inhibits invasion of urothelial cells

Front 20

what is the tx for proteus mirabilis?

(gram stain img--> gram neg)

Back 20

Penicillin and cephalosporins

(NOT susceptible to nitrofurantoin or tetracycline, inc resistance to ampicillin, trimethoprim, ciprofloxin)

Front 21

What gram (+) cocci organism can cause nitrite negative UTIs (most UTIs are nitrite (+)?

-catalase (+)

-coagulase (-)

-novobiocin resistant

-occurs in young sexually-active women, "honeymoon cystitis"

Back 21

Staphylococcus saprophyticus

(cause 5-15% UTIs)

Front 22

what organism?

brick red color

citrate utilization

gram - bacilli

facultative anaerobe

enterobactericeae family

+ for DNAse, gelatinase, lipase, citrate utilization

Back 22

serratia marcescens

Front 23

serratia marcescens was believed to be nonpathogenic & used by the military in biowarefare tests to track infections & in an experiment--->

sprayed serratia marcescens over the SF bay area to gauge a similar bio attack.

what was there an increase of in the hospitals?

Back 23

pneumonia and urinary tract infections

Front 24

enterococcus faecalis (closely related to group D strep faecalis- have lancefield antigen on C-carbohydrate) is a causative agent for what infections?

Back 24

endocarditis- bacteremia
cystitis
wound infections

normally found in GI tract

Front 25

enterococcus faecalis grown on blood agar will show what kind of hemolysi?

What else does it grow on?

Back 25

gamma hemolysis on blood agar

*remmeber that staph saprophyticus also does gamma hemolysis

also grows on bile-esculin agar (black discoloration) & 6.5% NaCl

Front 26

Enterococcus is PYR+, what will it produce on rxn w/ clinnamaldehyde reagent?

Back 26

red color

*d/t hydrolyzation of substrates

Front 27

25% of the genome for enterococcus faecalis is acquired how

Back 27

exogenously acquired DNA
Lateral gene trasnfer between genus and species (from staph & strep)

*pathogenicity island---> pore forming toxins & adherence genes

Front 28

what is the virulence factor for entereococcus faecalis

Back 28

abx resistance via ability to acquire mobile gene elements and rapid acquisition and dissemination of drug resistance

Front 29

what is the tx for enterococcus faecalis

Back 29

amoxicillin

ampicillin

vancomycin, resistance to this abx is appearing in e. faecalis

Front 30

what organism

non motile, G- rod

urease & nitrite (+)

can use citrate as sole carbon source

aerobic

endotoxin activity (LPS)

red currant like jelly polysaccharide capsule also called "k antigen"---> protects from phagocytosis & aids in adherence

large mucoid colonies on culture

Back 30

klebsiella

Front 31

klebsiella pneumoniae & oxytoca are considered opportunistic. Where are they normally found?

Back 31

normally found on mucosal surfaces & in environment-->

passed by hospital personnel-->

nosocomial infections (UTI, LRTI (bloody red currant sputum- hemoptysis), bilary tract, surgical wounds, meningitis, pneumonia, bacteremia)

Front 32

what is the tx for klebsiella

Back 32

cephalosporin

Front 33

this is part of the urogenital tract flora.

there is an increased risk of this infection with taking broad spectrum abx, pregnancy, diabetes, AIDS, surgery, in-dwelling catheters

What is the tx?

Back 33

candida sp.

*confirm w/ crystal violet stain

Tx: nystatin or clotrimazole

Front 34

at 37 deg C , candida will form what?

this is the first step in what transition?

why is this transition necessary?

Back 34

germ tubes

^formation induced by D-glucose in serum, at pH 7-8

* thus abx that destroy acid producing lactobacillus inc likelihood bc pH is inc

transition from yeast form to hyphal form--> necessary for virulence

Front 35

what can inhibit germ tube formation

Back 35

enzymatic destruction of D-glucose by glucose oxidase

no germ tube= no adherence or colonization
germ tube is cofactor necessary for adherence

*formation triggered by pH. temp, chemical inducers (environmental clues

Front 36

nosocomial UTI usually follow what

What pathogens are responsible?

Back 36

urinary catheterization ~66-86%
usu if catheterization is >4 days

E. coli, klebsiella, proteus, enterococcus, enterobacter, candida (endogenous bowel flora, usually acquired from self)

*psuedomonas cepacia & seratia marcescens*

Front 37

what is special about pseudomona cepacia and serratia marcescens

Back 37

these 2 don't commonly reside in the GI and therefore implies acquisition from exogenous source

*need to figure out where these pts acquired these organisms*

Front 38

summarize pseudomona cepacia

Back 38

not normally found in GI
a/w CF patients
G- rods
isolated from irrigation fluids, anesthetics, nebulizers, detergents, disinfectants
DOES NOT FERMENT - utilizes glucose, maltose, lactose mannitol,
oxidase and catalase positive
motile- polar tufts of flagella
yellow or green pigment

Front 39

catheters are susceptible to colonization by Proteus mirabilis

What does this lead to?

Back 39

urea --> ammonia the pH increases

--> stone formation and precipitation of phosphatic salts leading to blockage

(catheter encrustation)

Front 40

what can lead to renal failure dt obstructive uropathy, or pyelonephritis, or bladder carcinoma

Back 40

urinary tract schistosomiasis (schistosoma haematobium)

*Schistosoma haematobium eggs released in urine-->

eggs hatch & release miracidia in water-->

miracidia invade snail & develop into cercariae-->

cercariae released by snail into water-->

free-swimming cercariae penetrate skin-->

infection

Front 41

what can schistosoma haematobium cause in female genital tract?

Back 41

can cause lesions and may facilitate the spread of STDs such as HIV and HPV

also cause;

dysuria

frequency

terminal hematuria

Front 42

what will you see on labs of urinary schistosomiasis?

Back 42

identify and speciate eggs,

urinary excvretion of eggs isn't uniform throughout the day, need to quantify eggs via 24 hr urine collection

Front 43

how do you dx urinary schistosomiasis?

Tx?

(img of miracidia)

Back 43

*Egg viability test - watch for miracidia hatch

*UA culture
(UTI dt salmonella sp. is suspicion for urinary schistosomiasis (do blood cx for salmonella)
blood chemistries - renal panel
*CBC - eosinophilia and anemia

Tx: praziquantel (damages tegument membrane covering of worm--> exposing to host immune defense)

*test effectiveness of tx w egg viability test

Front 44

what do you look for on routine urinalysis

Back 44

physical properties - color, clarity, specific gravity
chemical properties- pH, protein, blood, nitrie, leukocyte esterase, glucose, ketones, bilirubin, urobilinogen--> UA findings
microscopic- RBC, WBC, casts, epithelial cells, bacteria, parasites, crystals

*microscopic only done if asked for, if cloudy, or if something on UA*

Front 45

how do we collect a "clean" urine sample

Back 45

midstream clean catch - least invasive way in obtaining a clean urine specimen

invasive ways = catheter, suprapubic aspiration

Front 46

what is the window of time you must test the collected urine? if not what should you do

Back 46

test within 1 hr of collection. if not, refrigerate immediately

Front 47

if a urine is the following colors,what does it indicate :
red brown
yellow brown to green
black brown
dark brown to red

Back 47

red brown hemoglobin
yellow brown to green bile
black brown melanin
dark brown to red porphyrin

Front 48

even thouhg odor is not considered of diagnostic significance, what do these things indicate

Back 48

freshly voided urine is aromatic
ammonia is dt breakdown of urea by urease
fruity odor= acetone/DM
foul odot= UTI, coliform bacteria
asparagus

Front 49

what 4 things will be positive on urine dipstick in UTI

Back 49

proteins = turquoise, glomeruli damage, or blood

blood = dark blue/green, renal dz, trauma, or hemolytic anemia

leukocytes = purple, granulocytic esterase

Nitrites = pink, gram neg bacteriuria, Griess's rxn

Front 50

what do hyaline casts (Tamm-Horsfall protein) usually look like?

What does a positive hyaline cast result indicate?

Back 50

blunt ends & scalloped edges

indicates capillary membrane damage w/ proteinuria

Front 51

what is the tx for the majority of UTIs

Back 51

trimethoprim-sulfamethoxazole (bactrim)

amoxicillin

fluoroquinolones

levaquin

Front 52

if the UTI are dt chlamydia trachomatis, mycoplasma hominis, what is the tx

Back 52

tetracycline or doxycycline

Front 53

women who are part of this particular group are at higher risk for recurrent UTI

Back 53

nonsecretors for a certain blood group (A, B, H) antigens